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243 Cards in this Set
- Front
- Back
Sexually transmitted diseases
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What are the three clinical stages of syphilis
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1st degree, 2nd degree, and thrid degree
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Lymphogranuloma venereum is caused by what organism?
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Chlamydia trachomatis
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A painless chancre is a sign of what disease?
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1st degree syphilis
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What organism causes chlamydia?
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Chlamydia trachomatis
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What are the clinical features of Gonorrhea?
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Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis
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What serotypes of Chlamydia trachomatis cause chlamydia?
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D-K
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What are the features of AIDS?
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Opportunistic infections, Kaposi's sarcoma, lymphoma
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The clinical feature of Trichomoniasis is what?
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Vaginitis
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Chancroid is caused by what organism?
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Haemophilus ducreyi
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Gummas, tables dorsalis, general paresis, aortitis, Argyll Robertson pupil are clinical features of what STD?
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3rd degree syphilis
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HSV-2 causes what disease with what features?
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Genital herpes with painful penile,vulvar, or cervical ulcers
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Ulcers, lymphadenopathy, and rectal strictures are signs of what disease?
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Lymphogranuloma venereum
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Which organisms cause Condylomata acuminata?
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HPV 6 and 11
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Hepatitis B causes what clinical feature?
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Jaundice
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What are the clinical features of 2nd degree syphilis?
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Fever, lymphadenopathy, skin rashes, condylomata lata
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Chancroid has what clinical feature?
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Painful genital ulcers
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What serotypes of Chlamydia trachomatis cause Lymphogranuloma venereum?
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L1-L3
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Trichomonas vaginalis causes what disease?
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Trichomoniasis
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Urethritis, cervicitis, conjunctivities, Reiter's syndrome, and PID are features of what diesease?
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Chlamydia
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Koilocytes are characteristic of what diease?
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Condylomata acuminata
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What organism causes 1st, 2nd, and 3rd degree syphilis?
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Treponema pallidum
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Pelvic inflammatory disease
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What are the top bugs that cause PID?
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Chlamydia trachomatis (subacute, often undiagnosed), Neisseria gonorrheae (acute, high fever)
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What is a risk factor for ectopic pregnancy, infertility, chronic pelvic pain, and adhesions?
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Salpingitis
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What is the most common STD in the US?
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Chlamydia trachomatis (3-4 million cases per year)
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What type of abscesses can occur in PID?
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Tubo-ovarian abscesses
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What does the chandelier sign test for?
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Cervical motion tenderness
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What are some of the manifestations of PID?
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Purulent cervical discharge, salpingitis, endometriosis, and hydrosalpinx
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What STDs other than C. trachomatis and N, gonorrhea cause PID?
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Gardnerella (clue cells) and Trichomonas (motile on wet prep)
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Nosocomial infections
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p. 207
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What are 2 of the most common causes of nosocomial infections?
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E. Coli (UTI) and S. aureus (wound infection)
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When in a renal dialysis unit which pathogen should you be concerned about?
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HBV (blood products)
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What is the most likely pathogen when a water source (water aerosols) is involved?
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Legionella
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What pathogen is often found on respiratory therapy equiptment?
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Pseudomonas aeruginosa (AIRuginosa when AIR or burns are involved?
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What are the two pathogens most commonly associated with urinary catheterization?
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E. coli and Proteus mirabilis
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Being in a newborn nursery is a risk factor for what pathogens?
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CMV and RSV
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Which pathogen would most associated with hyperalimentation (total parenteral nutrition)
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Candida albicans
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Infections dangerous in pregnancy
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What are the organisms that can cross the blood-placenta barrier and be dangerous in pregnancy?
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ToRCHcS=Toxoplasma, Rubella, CMV, HSV/HIV, Syphilis
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Bug hints (if all else fails)
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Name the associated bug
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Branching rods in oral infection
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Actinomyces israelii
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Surgical wound
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S. aureus
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Pus, empyema, abscess
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S. aureus
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Pediatric Infection
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Haemophilus influenzae (including epiglottis)
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Sepsis/meningitis in newborn
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Group B strep
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Dog or cat bite
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Pasteurella multocida
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Pneumonia in cystic fibrosis, burn infection
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Pseudomonas aeruginosa
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Currant jelly sputum
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Klebsiella
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Traumatic open wound
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Clostridium perfringens
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Antibody structure and function
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p. 208
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Which part of the light and heavy chain recognizes the antigen?
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Variable part
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The interchain and intrachain bonds in the antibody are of what type?
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Disulfide bonds
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What is the term called when the antibody prevents bacterial adherence?
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Neutralization
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The amino terminal is part of which fragment of the antibody?
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Fab fragment
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The fab fragment of the antibody is composed of which chain(s)?
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Light and heavy chains
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Describe the Fc fraction of the B cell receptor.
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Constant, Carboxy terminal, Complement-binding (IgG + IgM only), Carbohydrate side chains
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What is the purpose of opsonization?
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The antibody promotes phagocytosis
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The hypervarible region is a compontent of which fragment of the antibody?
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Fab fragment
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Only the heavy chain contributes to which fraction of the antibody?
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Fc
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Why does an antibody activate complement?
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To enhance opsonization and lysis
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The constant part of the heavy chain of IgM and IgG does what?
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Fixes complement
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Immunogloblulin isotypes
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p. 209
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Which isotype has an unclear function?
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IgD
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What is the main anitbody in a second response to an antigen?
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IgG
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When is IgM produced?
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Primary response to an antigen
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Which isotype induces the release of mediators from mast cells and basophils when exposed to an antigen?
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IgE
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Where is IgD found?
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On the surface of many B cells and in serum
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Which isotype fixes complement, crosses the placenta, opsonizes bacteria, and neutralizes bacterial toxins and viruses ?
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IgG
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Which isotype that guards the mucous membranes from attachement of bacteria and viruses?
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IgA
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IgE stimulates which type of hypersensitivity reaction?
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Type I
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IgE mediates immunity to what?
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Worms
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Which isotype fixes complement but does not cross the placenta?
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IgM
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Which isotype has the lowest concentration in the serum?
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IgE
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Which isotype found in secretions?
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IgA
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Which isotype crosses the placenta?
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IgG
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Ig epitopes
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Which Ig epitope is common to a single class of Ig (5 classes, determined by the heavy chain)?
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Isotype (IgG, IgA, IgM, IgE, IgD) Isotype=iso (same). Common to same class.
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Which Ig epitope is determined by antigen-binding site?
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Idiotype (specific for a given antigen) Idiotype=idio (unique). Hypervariable region is unique.
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Which Ig epitope differs among members of the same species and can be on the light or heavy chain?
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Allotype (polymorphism)
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MHC I and II
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Antigen presenting cells have which type(s) of MHC protein?
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MHC I and MHC II
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Which class MHC proteins is the main determinants of organ rejection?
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MHC II
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How many class I genes does the MHC consist of?
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3 (A, B, C)
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What class of MHC antigen loading occurs in acidified endosomes?
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MHC II
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All nucleated cells have which type of MHC protein(s)?
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MHC I
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Which class MHC protein has 1 polypeptide with beta 2 microglobin?
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MHC I
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Where does MHC I antigen loading occur in the cell?
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RER (viral antigens)
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What are the 3 MHC II genes?
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DP, DQ, DR
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Which class MHC protein has 2 polypeptides and and alpha and beta chain?
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MHC II
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Differentiation of B and T cells
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p. 210
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Which helper T cell is involved in antibody-mediated immunity?
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Th2 cell
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In an environment with a lot of IL-12, naïve helper T cells will mature to which helper T cell?
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Th1 cell
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Why do Th2 cells produce IL-4 and IL-5?
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To help B cells make antibody (B=2nd letter of alphabet)
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Gamma interferon is secreted by what cell to activate macrophages?
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Th1 cell
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Which growth factor induces the maturation from naïve helper T cell to Th2 cell?
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IL-4
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Th1 secretes what growth factor to activate CD8 cells?
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IL-2
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IL-4 and IL-5 are released from Th2 to activate what type of cell?
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B cell
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Why do Th1 cells produce IL-2 and gamma-interferon?
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To activate macrophages (increase killing efficiency of intracellular bacteria) and CD8 cells
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Which helper T cell is involved in cell-mediated immunity?Th1 cell
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Major function of B cells and T cells
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Choose either B (antibody-mediated immunity) or T cell (cell-mediated immunity)
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Allergy (hay fever)
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B cell
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Regulation of antibody response (help and suppression)
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T cell
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Autoimmunity
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B cell
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Allergy (poison oak)
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T cell
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Host defense against infection (opsonize bacteria, neutralize toxins and viruses)
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B cell
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Host defense against infection (especially Mycobacterium uberculosis, viruses, and fungi)
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T cell
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Graft and tumor rejection
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T cell
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Adjuvant definition
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What is the short definition of an adjuvant?
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That which aids another
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Human vaccines contain aluminum hydroxide or what?
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Lipid adjuvants
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Adjuvants are ________ stimulators of the immune response but are not immunogenic by themselves.
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Nonspecific
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What are adjuvants given with to enhance response?
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Weak immunogen
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T-cell glycoproteins
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p. 211
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Cytotoxic T cells have which type of co-receptor?
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CD8
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CD4 cell secretes which 3 cytokines to activate B cells?
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IL-2, IL-4, IL-5
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What is the CD3 complex?
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A cluster of polypeptides associated with a T-cell receptor. It is important in signal transduction
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When a cell first gets infected with a virus which three cells respond?
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APC, B cell (through IgM BCR), and CD8 (through TCR and MHC I on infected cell)
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Name three antigen-presenting cells.
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Macrophage, dendritic cell, and B cell
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CD4 are on which type of T cells?
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Helper T cells
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CD4 cell secretes which growth factor to activate the CD8 cells?
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IL-2
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CD4 on helper T cells bind to what?
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MHC II on antigen-presenting cells. Product of CD and MHC=8
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CD8 on cytotoxic T cells bind to what?
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MHC I on virus-infected cells. Product of CD and MHC=8
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T cell activation
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What recognizes the foreign antigen that is presented by MHC II?
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TCR on the Th cell
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IL-2 from the helper T cell activates which cell to kill virus-infected cells?
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Cytotoxic T cell
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A foreign body is phagocytosed by what type of cell?
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APC
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The helper T cell is activated to produce which two cytokines in cell-mediated immunity?
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IL-2 and gamma-interferon
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What recognizes endogenously synthesized (viral or self) proteins that are presented by MHC I?
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TCR on cytotoxic T cell
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What is the costimulatory signal needed for a helper T cell to be activated by MHC II on an APC?
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B7 (protein on APC) and CD28 (receptor on helper T cell)
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Anergy
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p. 212
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The state when an immune cell matures but does not respond to antigens, this process is called
..
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Anergy
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Anergy in both T and B cells is caused by
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Their response to a self-antigen
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Where are B cells exposed to self-antigen
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bone marrow
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Which type of cell is more sensitive to anergic stimulus?
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T cells
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Important Cytokines
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P. 212
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What cytokine is an endogenous pyrogen?
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IL-1
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Which major cytokines are produced by Macrophages?
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IL-1, IL-6, and TNF-alpha
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What are the effects of the cytokines produced by macrophages?
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(1) causes the liver to make more complement, (2) fever, (3) mobilizes neutrophils from bone marrow, (4)helpts T-cells migrate to lymph nodes and mature, therefore, helps acute phase reaction
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IL-1 by itself causes what effects?
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Fever, stimulates the growth and differentiation of T and B cells, neutrophils, fibroblasts and epithelial cells
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What cytokine stimulates the growth of helper T and NK cells
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IL-2
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What cells secrete IL-2
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Helper T cells
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What cytokine has the same effect as GM-CSF
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IL-3
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What cytokines promote the growth and differentiation of B cells
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IL-4, IL-5, TNF-alpha
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What cytokine stimulates the synthesis of IgE and IgG?
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IL-4
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What cytokine stimulates eosinophil production?
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IL-5
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T-helper cells secrete which cytokines?
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IL-2, IL-4, IL-5, gamma interferon
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What cytokine stimulates the synthesis of IgA?
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IL-5
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What cytokine acts to attract neutrophils?
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IL-8 (major) and TNF-alpha (minor)
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What cytokine stimulates macrophages?
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gamma-interferon
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What is the difference between TNF-alpha and TNF-beta?
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TNF-alpha is secreted by macrophages, and TNF-beta is secreted by T lymphocytes. Their functions are similar.
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What do TNF-alpha and TNF-beta do?
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increase IL-2 output and B-cell proliferation, attracts neutrophils
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Cell Surface Proteins
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p. 212
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What markers identify T cells
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TCR and CD3
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what cells have receptors for MHC I
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NK cells
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What does MHC I do?
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presents self-antigens, in viral infections the molecules presented by MHC I will change, which is why NK cells respond to viral infections best.
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What cells have MHC I on their surface?
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all cells except RBCs
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what does MHC II do?
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Presents non-self antigens
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What cells have MHC II?
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macrophages, monocytes, dendritic cells (called professional antigen presenting cells)
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What markers are specific for B cells?
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CD20, CD19, IgM
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What marker disappears when B cells become anergic?
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IgM is internalized in anergic cells
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What is a marker for Macrophages?
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CD14
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What is a marker for NK cells?
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receptors for MHC I, CD 16
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Acute Phase Response
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p. 213
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What cytokines are responsible for the Acute Phase Response?
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IL-1, IL-6, TNF-alpha
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How does the acute Phase Reaction cause a fever?
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IL-1 acts on the hypothalamus to increase body temp, fat is mobilized to increase energy, and muscle mass is used to create heat
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The Acute Phase Reaction involves the mobilization of which cells?
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B cells, T cells, Neutrophils
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Why is fever useful in an infection?
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Viruses and bacteria divide less in higher temperatures, it increases antigen production, and increases parts of the immunes response
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What does the liver do in the Acute Phase Reaction?
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Creates acute phase proteins (ex: C-reactive) which then activate complement and help in opsinization
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What does bone marrow do in the Acute Phase Reaction?
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Releases CSF which causes leukocytosis
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What do Dendritic cells do in the Acute Phase Reaction?
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the Professional antibody presenting cells migrate to the lymph nodes to initiate the adaptive response.
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Complement
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P. 214
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What kind of bacteria does complement act against?
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Gram negative
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Why does complement act preferentially against gram - bacteria?
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Complement initiators like to behind to carbohydrates, so gram- bacteria or noticed more than others.
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The classic pathway is initiated by
.?
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IgM or IgG (remember, GM makes Classic cars) antibody-antigen complexes
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The alternate pathway is initiated by
.?
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basically, everything else - endotoxins, microbial surfaces, IgA, etc.
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C1, C2, C3, C4 do what?
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Viral neutralization
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C3b does what?
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think B for Binding - anything that ends in b acts to opsinize bacteria
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What does C3a do?
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Think A for Inflame - anything that ends in a acts to increase the inflammatory response. C3a leads to anaphylaxis, along with C5a
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What is MC5b6,7,8,9?
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This is the name for the membrane attack complex that punches holes in membranes and actually kills the bacteria.
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What does a lack of C1 esterase cause and why?
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causes angioedema - which is basically overactive complement. This is because C1 is the initial step in the classic pathway, and if it cannot be limited, you over-react.
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What does a lack of C3 cause?
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sever and recurrent pyrogenic infections of the sinuses and UR tract, because C3 is the first common step in both pathways, and without it both pathways are crippled.
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Lack of C6, C7, and C8 cause what?
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Nisseria bacteremia. I have no idea why.
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Lack of decay accelerating factor (DAF) leads to what?
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Paroxysmal nocturnal hemaoglobinuria because the complement attacks the RBCs. DAF stops C3.
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What is the first step in the complement cascade that combines the two pathways?
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C3 activation
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What is the first step to bind to the cell membrane?
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C5a (after C5 is cleaved by C3 products)
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Interferon Mechanism
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P. 214
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What is the purpose of interferons?
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Interferons interfere is viral infection of cells and replication. They also activate NK cells to kill infected cells
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What do Alpha and beta interferon do?
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degrade viral mRNA, thereby inhibiting viral protein synthesis.
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what does gamma interferon do?
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upregulates MHC I and II in all cells
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Hypersensitivity
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P. 215
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What is another name for Type I hypersensitivity
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anaphylactic or atpoic
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What do type I, II, and III have in common?
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they all use antibodies
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What cells are involved in Type I?
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Mast cell and Basophils
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What Ig triggers Type one reactions?
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IgE
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What molecule acts as a mediator of this reaction?
|
IgE causes the release of histamine. This is a very fast reaction. Think First is Fast.
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What are some examples of Type I reactions?
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Anaphylactic shock, asthma, hives, local wheal and flare reactions.
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What is another name for Type II Hypersensitivity?
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Cytotoxic (think Cy-2-toxic)
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What happens in this reaction?
|
antibodies bind to a perceived "enemy" cell and use complement and phagocytosis to kill it.
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What antibodies are common in this reaction?
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IgM and IgG
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What are some examples of Type II reactions?
|
Goodpasture's, autoimmune hemolytic anemia, graves disease, rheumatic fever, etc.
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What do Type II and Type III have in common
|
They both use complement MAC (Membrane attack complexes) to do some of the work.
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What is different between Type II and Type III reactions
|
Type III reactions involve neutrophils and the release of a large number of cytokines and inflammatory mediators. Type II also happens to specific cells or tissues, while type III is soluble.
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What is the mechanism of a Type III Hypersensitivity Reaction?
|
Soluble antibody-antigen complexes activate complement and attract inflammatory cells
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What are some examples of this?
|
SLE, rheumatoid arthritis, etc
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What is serum sickness
|
When you have a type III reaction to a foreign protein, such as an injected drug. It takes about 5-10 days, and you present with fever, utricara, arthralgia, and proteinuria
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What is Arthus Reaction?
|
A local, subacute reaction to injected antibodies. Happens in the skin.
|
|
Examples of the Arthus reaction?
|
hypersensitivity pnemonitis and thermophilic actinomycetes
|
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What is the mechanism of a Type IV reaction?
|
This is T-cell mediated and therefore delayed. Think that 4 is last.
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What are examples of this type of reaction?
|
TB skin test, poison ivy, transplant rejection
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Immune Deficiencies
|
P. 216
|
|
Lack of B cells lead to what kind of disorders?
|
Lack of Ig
|
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Give two examples of this
..
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Burton's Agammaglobulinemia, Selective Immunoglobin deficiency
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Burton's agammaglobulinemia is caused by what?
|
X-linked defect that cause low levels in all Igs. Causes all kinds of bacterial infects. Think Boys and Bacteria for Burton's
|
|
At what age do the infections start in Burton's?
|
6 months, because that is when the maternal IgG declines.
|
|
What is the defect in Selective immunoglobulin deficiency?
|
A lack of a certain class of Ig, probably caused by a defect in iostype switching.
|
|
What Ig is most likely to be lacking?
|
IgA, which results in sinus and lung bacterial infections
|
|
What are three diseases that involve B and T cells?
|
Wiscott-Aldrich syndrome, and Ataxia-telangiactasia
|
|
What is SCID?
|
Stem cell defect (can be anything, no one gene), leads to total lack of an immune system.
|
|
How do the patients present?
|
patients present early with viral, bacterial, fungal, and protazoal infections
|
|
What is Wiskott-Aldritch Syndrome
|
an X-linked defect that results in depressed cellular immunity and IgM formation
|
|
How does it present?
|
Triad of Eczema, thrombocytopenia, and pyrogenic infections. There is a specific inability to fight off encapsulated bacteria
|
|
What are the Ig titers in a patient like this?
|
IgA is elevated, IgE is normal, and IgM is depressed
|
|
What is ataxia-telangiactasia?
|
Defect in DNA repair that leads to neurologic problems (ataxia) and spider angiomas (telangiectasia) and IgA deficiency
|
|
Name six phagocytotic disorders.
|
Il-12 receptor deficiency, Hyper IgM syndrome, Job's syndrome, Chediak-Higashi disease, Chronic granulomatous disease, Leukocyte adhesion syndrome. (Use: In Heaven Jesus Can Comtemplate Love, use Job to remember the biblical link)
|
|
What does Il-12 receptor deficiency cause?
|
Myobacterial infections
|
|
What does Hyper IgM syndrome cause?
|
Because the cells can't class switch, you have only IgM, and nothing else, resulting is never pyrogenic infections at 6 months
|
|
What will the titers look like in this disease?
|
High IgM, low IgA, IgE, and IgG
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What causes Job's disease?
|
T-cells fail to make interferon gamma and therefore neutrophils are not attracted to sites of infection
|
|
What is the clinical picture in Job's disease?
|
recurrent "cold" staph abscesses, eczema, and high levels of IgE
|
|
What is Chronic Granulomatous Disease?
|
a group of disorders that result in impaired neutrophils function
|
|
How does CGD present?
|
multiple opportunistic infections with bacteria
|
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What is the test for CGD?
|
negative nitoblue tertraolium dye reduction test
|
|
What is Chediak-Higashi disease?
|
autosomal recessive disease of microtubule dysfunction, leading to impaired phagocytosis
|
|
How does Chediak-Higashi disease present?
|
Multiple pyrogenic Staph and strep infections
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What is Leukocyte Adhesions deficiency syndrome?
|
deficiency of LFA-1 in phagocytotic cells, presents with pyrogenic infections
|
|
Of the phagocytotic disorders, which two do not present with pyrogenic bacterial infections?
|
Job's disease (no neutrophils action leads to "cold" abcesses) and IL-12 (mycobacterial infections)
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Passive vs. Active Immunity
|
P. 217
|
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What is active immunity?
|
slow onset, leads to long-lasting memory, happens after you are exposed to an antigen, basis for vaccines
|
|
What is passive immunity?
|
When you receive pre-formed antibodies, limited by the lifespan of the antibodies, rapid onset
|
|
What diseases are treated by using passive immunity?
|
Tetanus, Botulism, HBV, Rabies (To Be Healed Rapidly)
|
|
What Igs are used for this treatment?
|
high-affinity IgA and IgG
|
|
What is another scenario in which Igs are transferred from host to patient?
|
Maternal Igs are transferred to the infant.
|